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J Thorac Cardiovasc Surg 2005;129:472-474
© 2005 The American Association for Thoracic Surgery

Brief Communications

Selective reduction of the septolateral dimensions in functional mitral regurgitation by modified-shape ring annuloplasty

Francesco Maisano, MDa,*, Zvi Ziskind, MDa, Antonio Grimaldi, MDb, Andrea Blasio, MDa, Alessandro Caldarola, MDa, Michele De Bonis, MDa, Giovanni La Canna, MDb, Ottavio Alfieri, MDa

a Department of Cardiac Surgery
b Department of Non-invasive Diagnostic Cardiology, San Raffaele Foundation Institute and University Hospital, Milan, Italy

Received for publication May 20, 2004; accepted for publication June 1, 2004.

* Address for reprints: Francesco Maisano, MD, Cardiochirurgia, Istituto Scientifico Universitario, San Raffaele, Via Olgettina 60, 20132 Milano, Italy (E-mail: Francesco.maisono@hsr.it).

The first 20% of the full text of this article appears below.

Undersized annuloplasty is the conventional surgical treatment for functional mitral regurgitation (FMR).1 The rationale of this approach is the reduction the annular diameter to force leaflet coaptation. When this technique is performed with a conventional annuloplasty prosthesis, the transverse and septolateral dimensions are proportionally reduced. However, it has been suggested that the main determinant of malcoaptation in FMR is the increase of the septolateral dimension.2 Therefore, intercommissural distance reduction is probably unnecessary, if not detrimental (it may induce anterior leaflet folding and unnecessary reduction of the total mitral valve orifice area).

We herein present an alternative method for annuloplasty, designed to selectively reduce the septolateral dimension in FMR, which is intended to improve the results of mitral repair in this challenging group of patients.3


   Surgical technique and clinical experience
 
A Carpentier rigid ring (Edwards Lifesciences Inc, Irvine, Calif) was chosen because it contains a metal core that can be reshaped. Prosthesis size was selected by measuring the intertrigonal distance and was undersized by 1 size. Before implantation, the ring was reshaped according to the sequence illustrated in Figure 1 by use of 2 tubing clamps. Shape modification created a prosthesis with the intertrigonal distance upsized . . . [Full Text of this Article]






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